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How we examine a chalazion (eyelid lump) to figure out what to do

When you come to Clinica London to see us about your chalazion, and you are wondering whether we are going to recommend incision and curettage, you will have to have the eyelid lump examined.
First of all, we test your visual acuity in each eye, because if you have an eyelid lump that needs surgery, you will need to wear an eye patch for 24 hours afterwards. Because you will not be able to see with that eye, we need to know that you have good vision in the other eye, so that you will cope while you have the eye pad on.
If by any chance the vision in the other eye is not good then we will take special precautions so that you only have to put the eye pad on the operated eye for a very short time.
Therefore, we will keep you in the clinic for a longer period afterwards so that we can observe your eyelid and make sure that you are all right to go home without an eye pad on.  Alternatively, you may be able to leave the clinic in a taxi and keep the eye pad on for a few hours at home with someone there to look after you.
After you have had your visual acuity tested, we will take your history and find out how long you have had the lump. We will want to know how it has behaved, whether it is the first one you have ever had and whether you have had any previous experience of incision and curettage. We will also want to know whether you have been under any particular stress or if there is anything else that may have brought it on. We will also we will ask whether this condition runs in the family.
I will then examine your eyelids at the slit lamp, which is a biomicroscope used by ophthalmologists which gives a x10 or x16 magnification. With the slit lamp, I can see whether there are any crusts on your eyelashes or any collarettes around the roots of the eyelashes. I can see where the individual meibomian glands are not functioning well, or if there is a blockage. I can turn the eyelid so that I can examine the tarsal conjunctiva, where will sometimes be more chalazia visible than on the outside.
The inside of the eyelid is also where I will do the incision and curettage, hiding any incision from direct view and not going through the skin’s surface. Only very rarely do I have to go through the skin if the chalazion has developed forwards into the skin with a small abscess, or even leaving a fibrous lump that I will need to excise. Usually, using the combination of your visual acuity, your history and the examination under the slit lamp, I can figure out what to do for your chalazion and whether it needs initial medical treatment or surgical treatment.


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